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1.  Weaning from the breast 
Paediatrics & Child Health  2013;18(4):210.
Exclusive breastfeeding provides optimal nutrition for infants until they are six months of age. After six months, infants require complementary foods to meet their nutritional needs. This is when weaning begins. Weaning is the gradual process of introducing complementary foods to an infant’s diet while continuing to breastfeed.
There is no universally accepted or scientifically proven time when all breastfeeding must stop. The timing and process of weaning need to be individualized by mother and child. Weaning might be abrupt or gradual, take weeks or several months, be child-led or mother-led. Physicians need to guide and support mothers through the weaning process. This document replaces a previous Canadian Paediatric Society position statement on weaning published in 2004.
PMCID: PMC3805627  PMID: 24421692
Breastfeeding; Breast milk; Complementary foods; Infant; Weaning
4.  Caring for Kids New to Canada 
Paediatrics & Child Health  2013;18(4):179.
PMCID: PMC3805616  PMID: 24421683
6.  Development and validation of a self-efficacy scale for clinical decision-making in general paediatrics 
Paediatrics & Child Health  2013;18(4):184-188.
BACKGROUND:
Success in a task is not only related to skill, but it is also related to ‘self-efficacy’, or belief in one’s capability to perform that task. No tool currently exists to measure self-efficacy in clinical decision-making in general paediatrics.
OBJECTIVE:
To develop and provide validity evidence for the General Pediatrics-specific Self-Efficacy (GPedsSE) scale.
METHODS:
The five-item GPedsSE scale, developed using an expert panel, was matched to the New General Self-Efficacy (NGSE) scale’s structure for validity analysis purposes. Thirty-six postgraduate year 1 to postgraduate year 5 paediatric residents of the Montreal Children’s Hospital (Montreal, Quebec) completed the GPedsSE and NGSE scales, with items interspersed.
RESULTS:
The mean (± SD) GPedsSE score was 18.6±2.6 of 25. Total GPedsSE and NGSE scores were moderately correlated (r=0.54, P<0.005). On planned comparison, the GPedsSE score increased with training year (F[1.3]=6.62; P<0.001), while the NGSE score did not (F<0.37). Exploratory factor analysis showed two components, each aligning with a scale.
CONCLUSION:
The GPedsSE scale contextualizes an existing tool to general paediatrics, a novel concurrent validity approach.
PMCID: PMC3805618  PMID: 24421685
General paediatrics; Medical; Residency; Self-efficacy
7.  A survey of the management of newborns with severe hemophilia in Canada 
Paediatrics & Child Health  2013;18(4):189-193.
OBJECTIVE
To determine the practice patterns of Canadian hematologists and neonatologists/paediatricians who care for newborns with hemophilia, with regard to vitamin K administration, use of empirical clotting factor replacement therapy, neuroimaging and timing of hematology consultation.
METHODS:
Hematologists and neonatologists/paediatricians, identified from membership lists of Canadian professional organizations, were provided electronic and/or paper versions of the survey instrument. Questions were posed in the context of specific clinical scenarios. Differences in response proportions between groups were compared for selected questions.
RESULTS:
There were 171 respondents among 616 eligible persons who were sent the survey; 58 respondents had recent experience managing a newborn with hemophilia. There was a consensus not to provide empirical treatment to well newborns after uncomplicated deliveries, to provide empirical treatment to symptomatic newborns and to obtain neuroimaging for symptomatic newborns. Systematic differences between hematologists and neonatologists/paediatricians existed with regard to the timing of hematology consultation when the diagnosis of hemophilia had not been confirmed antenatally, the route of vitamin K administration for newborns with hemophilia and the choice of product to use for empirical treatment of a symptomatic newborn.
CONCLUSIONS:
The observed lack of consensus regarding important management decisions indicates a need for ongoing research in the care of newborns with hemophilia. Systematic differences between hematologists and neonatologists/paediatricians suggest a role for improved communication and collaboration between these two groups of practitioners.
PMCID: PMC3805619  PMID: 24421686
Hemophilia A; Hemophilia B; Intracranial hemorrhages; Neuroimaging; Newborn
8.  Limb length shortening associated with femoral arterial lines in the neonatal period 
Paediatrics & Child Health  2013;18(4):194-196.
Two cases involving toddlers who presented with limb length shortening and radiological findings consistent with growth plate arrest are presented. Both cases had been cared for in the neonatal intensive care unit because of extreme prematurity, and both cases had a femoral arterial line inserted on the side of the body with the short limb. This complication has not been previously described in the preterm population.
PMCID: PMC3805620  PMID: 24421687
Femoral arterial lines; Growth plate arrest; Limb length shortening; Prematurity
11.  Sport nutrition for young athletes 
Paediatrics & Child Health  2013;18(4):200-202.
Nutrition is an important part of sport performance for young athletes, in addition to allowing for optimal growth and development. Macronutrients, micronutrients and fluids in the proper amounts are essential to provide energy for growth and activity. To optimize performance, young athletes need to learn what, when and how to eat and drink before, during and after activity.
PMCID: PMC3805623  PMID: 24421690
Adolescents; Athletes; Children; Nutrition; Sports
13.  Nutrition for healthy term infants, birth to six months: An overview 
Paediatrics & Child Health  2013;18(4):206-207.
Nutrition for healthy term infants is a joint statement by Health Canada, the Canadian Paediatric Society, Dietitians of Canada and the Breastfeeding Committee for Canada that was most recently updated in September 2012 with recommendations from birth to six months of age. This practice point outlines the development process, principles of infant feeding, and recommendations for clinicians. Health professionals involved in counselling families about infant nutrition are advised to read the statement in its entirety, because the underlying discussions expand upon and clarify the advice summarized in the principles and recommendations. The complete statement is available on Health Canada’s website (www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php).
PMCID: PMC3805625  PMID: 24421691
Breastfeeding; Evidence-based; Feeding; Growth; Infants; Nutrition; Vitamin D
15.  Le sevrage de l’allaitement 
Paediatrics & Child Health  2013;18(4):211.
RÉSUMÉ
L’allaitement exclusif assure une alimentation optimale aux nourrissons jusqu’à l’âge de six mois. Par la suite, les nourrissons ont besoin d’aliments complémentaires pour répondre à leurs besoins nutritionnels. C’est alors que le sevrage commence. Le sevrage désigne le processus graduel d’introduction d’aliments complémentaires au régime du nourrisson, tout en poursuivant l’allaitement.
Il n’y a pas de moment universellement accepté ou scientifiquement démontré pour mettre un terme à l’allaitement. Le moment et le processus de sevrage doivent être adaptés par la mère et l’enfant. Le sevrage peut être soudain ou graduel, prendre plusieurs semaines ou plusieurs mois, être dirigé par l’enfant ou par la mère. Les médecins doivent orienter et soutenir les mères tout au long du processus de sevrage. Le présent document remplace le document de principes sur le sevrage qu’a publié la Société canadienne de pédiatrie en 2004.
PMCID: PMC3805628
Breastfeeding; Breast milk; Complementary foods; Infant; Weaning
16.  Paediatricians’ awareness of children’s oral health: Knowledge, training, attitudes and practices among Turkish paediatricians 
Paediatrics & Child Health  2013;18(4):e15-e19.
BACKGROUND:
In Turkey, 74.1% of children between three and six years of age develop dental caries.
OBJECTIVE:
To assess the depth of oral health and dental knowledge among paediatricians in Turkey, to determine their level of oral health education and to determine factors that were associated with higher knowledge scores.
METHODS:
A cross-sectional survey of demographics that assessed the participants’ knowledge of oral and dental health, attitudes regarding oral health during well-child visits and opinions regarding infant oral health care visits was conducted. The outcome variables were the proportions of paediatricians who adhered to good clinical practice guidelines, recommended dental visits for children younger than one year of age, and having a knowledge score >50%.
RESULTS:
The participant characteristics that were significantly associated with a greater mean number of correct answers were female sex, good clinical practice, confidence in detecting dental caries and the presence of a dentistry department in their hospital (P=0.001, P<0.001, P<0.001 and P=0.02, respectively). Only 13.9% of paediatricians referred children younger than one year of age to a dentist. After adjusting for the level of oral health education received during residency training, sex and having children, only the knowledge score was significantly associated with referring patients younger than one year of age to a dentist (P=0.01).
CONCLUSIONS:
Some paediatricians’ knowledge was found to be associated with practices that were in accordance with professional society recommendations. The lack of dental knowledge and training in residency limits the paediatricians’ role in promoting children’s oral health in daily practice.
PMCID: PMC3805629  PMID: 24421693
Dental caries; Education; Knowledge; Oral health; Physicians
17.  Letter to the Editor 
Paediatrics & Child Health  2013;18(3):121.
PMCID: PMC3680278  PMID: 24421669
18.  An approach to patients 
Paediatrics & Child Health  2013;18(3):123-124.
PMCID: PMC3680279  PMID: 24421670
19.  Burns and beauty nails 
Paediatrics & Child Health  2013;18(3):125-126.
A case involving a five-month-old girl brought to the emergency department with burns over her abdomen is described. The child was reported to have spilled two small bottles of beauty nail adhesive on her clothes while her mother was preparing dinner. After undressing the infant, the mother discovered several lesions on the child’s abdomen and quickly sought medical attention. Given the unusual circumstances of the presentation, the child was hospitalized for both treatment and supervision. The beauty nail adhesive contained cyanoacrylate. In addition to its well-appreciated adhesive capacity, cyanoacrylate, in the presence of cotton or other tissues, is known to produce an exothermic reaction that may cause burns. Cyanoacrylate-based products, due to their possible adverse effects, should be kept away from children as advised. Odd injuries should always raise concerns about the possibility of inflicted injury.
PMCID: PMC3680280  PMID: 24421671
Burns; Child; Cyanoacrylate; Safety
20.  The significance of early childhood adversity 
Paediatrics & Child Health  2013;18(3):127-128.
PMCID: PMC3680281  PMID: 24421672
21.  Adolescents’ comfort answering questions about sexuality asked by their physicians 
Paediatrics & Child Health  2013;18(3):129-133.
OBJECTIVE:
To evaluate the attitudes of adolescents toward communicating with their doctor about different aspects of their sexuality.
METHODS:
The present descriptive survey was conducted with the participation of teenagers from four high schools in Sherbrooke, Quebec. In each school, the students of two grade 8 classes (≤14 years of age) and two grade 10 classes (≥15 years of age) anonymously completed a self-administered questionnaire. Permission from the school board and parental consent for every participant was obtained.
RESULTS:
A total of 387 adolescents completed the self-administered questionnaire. The response rate for the study was 98%. Only 27% of the respondents remembered being questioned by their doctor about sexuality, and 17% of the respondents had already brought up the topic of sexuality themselves with their doctor. More than one-half (57%) of the adolescents reported they would be moderately comfortable to totally comfortable discussing sexuality with their doctor if they felt the need to. Overall, when asked to evaluate their degree of comfort if questioned on specific questions about their sexuality, 73.8% to 99.5% believed they would be moderately to totally comfortable responding. Nevertheless, there was a statistically significant difference between age groups, with the older age group being more comfortable than the younger age group (P<0.001). There was no difference between the level of comfort among boys and girls answering the same questions. Respondents believed that their treating physician should discuss sexuality with them (73.8%) and, in the majority of cases (78%), that he/she should initiate the conversation.
CONCLUSION:
Regardless of age or sex, teenagers considered themselves to be at ease discussing sexuality with their doctor and found it an important topic best brought up by their practitioner.
PMCID: PMC3680282  PMID: 24421673
Adolescents; Communication; Physician practice patterns; Sexuality
22.  Does the use of oral nonabsorbable antifungal prophylaxis reduce the incidence of fungal colonization and/or systemic infection in preterm infants? 
Paediatrics & Child Health  2013;18(3):134-136.
BACKGROUND:
Invasive fungal infection is a significant cause of mortality and morbidity in preterm infants. Oral nonabsorbable agents are used prophylactically, but the literature regarding their effectiveness has not been systematically reviewed.
OBJECTIVE:
To determine if oral nonabsorbable antifungal prophylaxis reduces the incidence of fungal colonization and/or systemic infection in preterm infants.
METHODS:
The literature was reviewed using the methodology for systematic reviews for the Consensus on Resuscitation Science adapted from the American Heart Association’s International Liaison Committee on Resuscitation.
RESULTS:
Five studies were reviewed. Three level of evidence 1 studies and two level of evidence 3/4 studies provided evidence that the prophylactic use of oral nonabsorbable antifungal agents can reduce the incidence of fungal colonization and/or systemic fungal infection in preterm infants.
CONCLUSION:
Prophylactic oral nonabsorbable antifungal medications are an acceptable approach to reduce colonization and invasive fungal infection in preterm infants in units with high baseline colonization rates.
PMCID: PMC3680283  PMID: 24421674
Antifungal agents; Fungal colonization; Fungal infection; Prophylaxis

Results 1-25 (932)